Provider Demographics
NPI:1629378823
Name:CHILDERS, ASHLEY LUNA (PA - C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LUNA
Last Name:CHILDERS
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Gender:F
Credentials:PA - C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1950 GLENN MITCHELL DR
Mailing Address - Street 2:STE 300
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0048
Mailing Address - Country:US
Mailing Address - Phone:757-507-0305
Mailing Address - Fax:757-507-0306
Practice Address - Street 1:1950 GLENN MITCHELL DR
Practice Address - Street 2:STE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0048
Practice Address - Country:US
Practice Address - Phone:757-507-0305
Practice Address - Fax:757-507-0306
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant